Barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria: A qualitative study exploring views and experiences of decision‐makers in secondary schools

Abstract Background and Aims Schools represent a unique setting for promoting lifelong physical activity during critical development stages of life. Opportunities for in‐school physical activity largely depend upon school‐level policies, practices, and administrative support. A significant information gap exists on the factors influencing adolescents' participation in school‐based physical activity programs in Nigeria. This study aimed to identify and explore the barriers and facilitators of physical activity in school‐attending adolescents in Lagos State, Nigeria. Methods A qualitative study, using semistructured interviews, was conducted to explore the views and experiences of 21 decision‐makers who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria. Data were analyzed using the thematic analysis framework. Results Eight themes were identified and explored. The barriers were (i) students' characteristics, (ii) parental objections, (iii) no prioritization of physical activity, (iv) insufficient resources, and (v) challenges with schools' initiatives. The facilitators were (vi) students' interests, (vii) students' awareness of benefits, and (viii) schools' initiatives. Conclusion Our study findings can help in designing interventions to increase physical activity among school‐attending adolescents in Lagos, Nigeria.

Despite the benefits accrued from being physically active; only approximately 19% of the global school-going adolescents reach the level recommended by the World Health Organization (WHO); however, this is even lower in sub-Saharan Africa, where only 13.8% of school adolescents are reported to reach the recommended level. 5 The WHO recommends that schools should provide quality physical and health education that supports adolescents to develop healthy behavior patterns that will keep them physically active throughout their lives. 1 In keeping with this recommendation, Nigeria developed a National School Health Policy in 2006, which proposes practising physical activities for the health, academic, and remediable problems (e.g., sleep problems, substance use) of school adolescents. 6 However, very little is known on the implementation of this policy in schools. 7 Current evidence suggests that the overall physical activity levels in Nigerian school adolescents are low, ranging from 5% to 37%. [8][9][10] These studies have reported some sociodemographic factors such as religion, parents, socioeconomic status, number of children in the family, motivation, self-efficacy, age, and weight status as factors associated with physical activity. Studies conducted in Lagos State have shown that the type of schools adolescents attend can impact their participation in physical activities. 11 There is also evidence of increased participation in physical activities of adolescents in schools following a professional development training program for teachers to promote physical activity in adolescents in Lagos State. 12 Lagos State occupies a unique position in Nigeria as the country's largest urban area, and it has over a thousand secondary schools to accommodate its teeming adolescent population. 13 With urbanization comes the inequitable distribution of resources that impact physical activity. 14 Physical activity in Lagos particularly for the lower socioeconomic group, which comprises most of its residents, is undertaken in unsupportive and potentially harmful environments while navigating dangers such as air pollution and road traffic injury. 15 Schools, however, represent a unique setting for promoting lifelong physical activity during critical development stages of life. 16 Opportunities for in-school physical activity largely depend upon school-level policies, practices, and administrative support. 17 A significant information gap exists on the factors influencing adolescents' participation in school-based physical activity programs in Nigeria. 7 No study has considered the experiences and views of key decision-makers in schools who are responsible for the management of schools in Lagos State, Nigeria. Interventions to promote physical activity in adolescents should be informed by knowledge of the factors that influence it. 18 Therefore, this study identified and explored the views and experiences of school decision-makers on the barriers and facilitators of physical activity among school-attending adolescents in Lagos State, Nigeria.

| Study design
A qualitative study was conducted to address the aim of the study and the study was reported according to the COREQ guidelines of reporting qualitative studies. 19

| Study participants
The study participants were decision-makers, such as principals, viceprincipals, and district and state officials in the Lagos State Ministry of Education, responsible for planning the physical and health education curriculum of secondary schools. They were from schools that were selected using stratified random sampling. In the first stage, schools were stratified by local government area and then by school type using the master list accessed from the official internet portal of all schools in Lagos State. 20 School officials who were not responsible for the curriculum planning were excluded.

| Recruitment
Decision-makers in one of the six districts of Education in Lagos State, which has over 150 public and private secondary schools, were contacted through their offices. They were briefed about the research aims and their willingness to participate; they were given a participant information sheet that contained detailed information about the purpose of the study, why they were approached, and the confidentiality of the data. The participant was given an informed consent form signed by both the lead researcher and the participant. Then, the place, date, and time to conduct the interview were scheduled.

| Interview guide
The interview guide was developed using previous literature that has identified and explored the barriers and facilitators of physical activity in school adolescents among decision-makers in schools. 21,22 The interview guide had 10 questions which included questions asking: Is physical and health education offered in your school as a subject? Could you please tell me about the physical activity participation of the students in your school? Could you please tell me about students' physical activity levels in your school? Could you please share your thoughts on the things preventing students from getting more exercise in school?
What things could the school do to make it easier for students to get more physical activity at school? If physical activity opportunities are improved, how do you think this might affect the current schools' curriculum? How inclusive will you describe the physical activities offered in your school? Could you please share your thoughts on how culturally sensitive issues (religion, culture) influence physical activity participation among the students? How will you describe teachers' motivation to be involved during physical activities in your school? The interview guide had questions that allowed probing of participants' responses. The interview guide was piloted with one school principal, and the transcript was included in the data as no changes were made to the interview guide.

| Data collection
A trained qualitative researcher conducted the semistructured interviews. Face-to-face interviews in the participants' places of work (schools/offices) were planned for all the interviews, but due to the COVID-19 pandemic, 12 interviews were conducted over the phone. The interviews were recorded with permission using a digital recorder. The interviews were conducted from March to September 2020 in English since it is the country's official language.

| Data analysis
The lead researcher transcribed three of the interviews verbatim, and the remaining 18 were transcribed verbatim by a professional transcriber after signing a nondisclosure agreement. All identifiable information was removed. All the transcripts were compared against the recordings for accuracy, and any discrepancies were corrected. The lead researcher read the transcripts several times to become familiar with the data. Data were analyzed using the deductive thematic analysis framework of Braun and Clarke. 23 The first interview transcript was analyzed by hand by the lead researcher to generate the initial codes. Subsequent transcripts were analyzed using NVivo 12 (QSR International Ltd). Codes were organized into overarching categories, after which themes and subthemes were assigned. The lead researcher reviewed themes to ensure that they were distinct and not overlapping.
The process was continuously discussed with senior study authors to refine the themes. The themes were further considered in relation to the whole data set to ensure they accurately reflected the data set.
Anonymized quotes annotated by role and type of school are presented to support the defined themes. During the analysis, the lead researcher referred to her reflexivity notes to examine how her beliefs and judgments could have influenced the findings. 24 For the reflexivity notes, the lead researcher was aware of her gender and her experience of the physical and health education classes she attended in secondary school; therefore, the interview guide prepared beforehand helped to mitigate the effects of the researcher's bias in the interviews.

| RESULTS
Twenty-one school decision-makers were interviewed. Ten (six principals and four vice-principals) were from private schools, and eight (two principals and six vice-principals) were from public schools.
The remaining three participants were district and state officials in the Lagos State Ministry of Education. Fourteen participants were males. The semistructured interviews ranged from 8 to 50 min (mean duration of 20 min).

| THEMES
A total of eight themes categorized into student-, parent-, and school-related barriers and facilitators were identified and explored. Five were barriers, and three were facilitators. The barriers were (i) students' characteristics, (ii) parental objections, (iii) no prioritization of physical activity, (iv) insufficient resources, and (v) challenges with schools' initiatives. The facilitators were (vi) students' interest, (vii) students' awareness of benefits, and (viii) schools' initiatives. Table 1 shows the themes and subthemes of the barriers and facilitators.

Students' characteristics
This theme describes how students' attributes, such as physical disabilities, health status, or sex differences, prevented them from being physically active. This theme comprises six subthemes. It was also noted that such students were avoided by their peers during physical activities even if they showed interest.
"We have some students that are SS, and because some students want to play safe, once those SS get to the field, you will hear others shouting, "I'm not playing ball with you," they only just want to play safe and not get into any trouble." [Principal, Private School] Two participants mentioned that overweight students were usually not interested in physical activity. There were also some comments regarding the poor participation of girls in physical activity, due to boys' monopolization of the schools' playgrounds, particularly for football.
"But you know how boys do now? Boys play football every day, and sometimes when the girls feel like they want to play, they approach me or tell somebody else that we should please chase the boys away; they want to play." [Principal, Private School] Some participants commented on how religious norms, like the accepted mode of dressing, affected girls' participation in physical activity.

| DISCUSSION
This study identified and explored five barriers and three facilitators to physical activity in school-attending adolescents among decisionmakers in secondary schools in Lagos State, Nigeria. These were categorized into student-, parent-, and school-related barriers and facilitators.
Our study found students' poor participation in physical activities due to physical disabilities, body image concerns, health status, or lack of interest. Our finding of the exclusion of adolescents with physical disabilities and health challenges by their peers is similar to the finding reported in a scoping review which explored the barriers and facilitators to participation in adolescents in low-and middle-income countries. They reported that adolescents with physical disabilities were excluded by their peers and this made them feel embarrassed at appearing physically inept. 25 In addition, lack of interest in physical activity and laziness were also reported as barriers in a study that was conducted in Morocco, North Africa. 22 Our study's finding regarding overweight students not participating in physical activity is similar to a study that showed that overweight students were discriminated against for negative expectations about their physical ability by their peers or teachers. This was reported to affect their participation in physical activities. 26 Existing evidence from a narrative review which included data from 1983 to 2013 reported that about 1.0%−8.6% of Nigerian adolescents were overweight. 27  Finally, our study shows that the senior (last 3 years of secondary school) students do not usually offer physical activity as a subject.
The Lagos State Government should consider scheduling physical activity for senior students, whom our study has identified to lack a structured time for physical education classes. Additionally, stakeholders should ensure that the scheduled classes, for all students, guarantee students' participation in physical activity as is done in other parts of the world and not just the theoretical aspect. 45,46 6 | STRENGTHS AND WEAKNESSES To our knowledge, this is the first qualitative study that identifies and explores the barriers and facilitators of physical activity among school adolescents in Lagos State, Nigeria. One of the strengths of this study is the diversity of the interviewed decision-makers, which made us explore different views and experiences. Interviewing private and public school participants helped generate transferrable insights into both schools in Lagos State, Nigeria. Also, the semistructured interview allowed the lead researcher to delve deeply into the participants' responses, thereby generating more insights into the research aims. We reached data saturation of findings at the 14th interview; we, however, continued the interviews to ensure that we did not miss any unique information.
A potential weakness is that the average length of the interviews (20 min) seemed insufficient to explore views and experiences deeply. However, this is unlikely to have affected the findings since the same interview guide was used. Also, the similarity of our findings to those from other similar studies shows the richness of the data generated by our interviews. We acknowledge that our population has demographics and cultural characteristics which do not allow generalizability to be inferred, but we have addressed this by providing a comprehensive description of the context of the study.

| CONCLUSIONS
Our study identified and explored student-related, school-related, and parent-related barriers and facilitators of physical activity in students in Lagos State. Our study's findings can help design interventions to increase physical activity among school-attending adolescents in Lagos, Nigeria.